ESOC 2021 | Clinical management of patients with AF who have had a stroke

In the last ESOC meeting, I talked about clinical management of patients with atrial fibrillation that have had a stroke. So, what I did, basically, was to talk what is defined actually now in the guidelines. And it’s very important to remember that all patients that have had a stroke or a TIA and have atrial fibrillation need to be treated with anticoagulation. And it’s really important that these patients are treated according to what is prescribed or what is defined on the label of those medicines. Because if we under treat these patients with underdoses, we are not protecting the patients. Actually, we are just increasing the risk of having a stroke recurrence, and also the risk of having a bleeding. So, there is no really clear benefit for the patient. So, these patients that have had a stroke or a TIA, and have simultaneous atrial fibrillation, if there’s no contraindication, they should be anticoagulated, and according to the doses that have been defined.

There are clinical trials that have been done a couple of years ago that showed that patients that have had a stroke and have atrial fibrillation need to be anticoagulated, and that anticoagulation is superior to treatment with antiplatelets. And there are several Phase IV studies that continued observation of patients that have been included in the clinical trials and they’ve evaluated newer anticoagulants, and it showed that underdosing these patients leads to a higher risk of having subsequent strokes.

So, underdosing is not an answer for those patients for which the prescribers or the doctors think that are increased risk of bleeding, because if the medicines are not prescribed according to what was defined in clinical trials, and according to what is defined on the label, these patients are not protected against subsequent stroke. They are not anticoagulated.